Pathologic yawning: neurologic aspects

K K Jain MD (Dr. Jain is a consultant in neurology and has no relevant financial relationships to disclose.)Originally released October 11, 2014; last updated September 22, 2018; expires September 22, 2021

Excessive yawning is increasingly being recognized as a manifestation of neurologic disorders. Several neurotransmitters and neurohormones are involved in the regulation of yawning. Several areas in the brain are implicated, but no definite center for yawning has been identified. According to the thermoregulatory theory of yawning, its function is to cool the brain, and excessive yawning may be a symptom of conditions that increase brain temperature. Differential diagnosis requires consideration of various disorders linked to excessive yawning. Treatment involves addressing the basic disorder. Propranolol can reduce the severity of yawning.

Key points

• Previously considered to be a sign of boredom and drowsiness, excessive yawning is now increasingly linked to neurologic disorders.

• Several neurotransmitters and neurohormones are involved in the neuropharmacologic regulation of yawning.

• According to the thermoregulatory theory of yawning, its function is to cool the brain, and excessive yawning may be a symptom of conditions that increase brain temperature.

• Several drugs are reported to induce yawning, and this should be taken into consideration in the differential diagnosis.

• Propranolol, a beta blocker, has been found to reduce the severity of yawning.

Historical note and terminology

A yawn is an involuntary sequence of mouth opening, retraction of the tongue, deep inspiration, brief apnea, and slow expiration. Yawning lasts 5 to 10 seconds and is accompanied by generalized stretching of body musculature, particularly the arms, as well as respiratory muscles. Yawning, like swallowing, is a reflexive phenomenon that is often repetitive and is extremely difficult to modify by voluntary action. Excessive yawning is defined as 3 or more yawns per 15 minutes.

Since antiquity, yawning has attracted a moderate interest among philosophers, psychologists, physiologists, and physicians. Hippocrates listed yawning as 1 of the useful “natures,” and Darwin mentioned it in connection with emotional behavior (Schiller 2002). Yawning was described as a tic-like disorder in a monograph (Meige and Feindel 1902).

Historically, yawning has been associated with drowsiness and boredom, but this age-old belief is changing as newer studies have shown the significance of yawning in physiology and as a symptom of various disorders (Gupta and Mittal 2013). Although yawning is considered a stereotyped action pattern, there are substantial variations in this response. Yawn duration is a predictor of mammalian brain weight and cortical neuron number, and primates have longer and more variable durations of yawning compared with other mammals (Gallup et al 2016a). Repetitive yawning is pathological and the number of yawns per day can exceed 100 (Walusinski 2018).

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